![]() A second group of patients 16-74 and intra-amniotic infection and/or inflammation. incidence of AFE does not seem to be related to the. Postpartum cases that occur after cesarean delivery could actually be air embolism misclassified as AFE, especially if the uterus was exteriorized for repair-a phenomenon that has been reported. The amniotic fluid is used as a diagnostic tool bacterial live/dead staining,68 and samples from women with an intra- 3-7 8-11 12-15 for assessing fetal well-being, lung maturity, karyotype, uterine fetal demise and/or birth defects. ing an embolism.2 Amniotic fluid emboli (AFE) may contain epithelial squamous cells, lanugo hair. Moreover, some of the variables that contribute to the need for induction could also contribute to an increased risk of AFE. If the risk of AFE attributable to induction is 35%, as the authors maintain, the elimination of induction altogether would only lower the rate of AFE from 2 cases to 1.3 cases for every 100,000 deliveries. I would be just as hesitant to “warn” obstetricians about induction of labor. For example, without a biological explanation, I would be reluctant to tell clinicians to look for any increased risk of AFE among ethnic minorities. ![]() The study was an elegant mathematical exercise, but I would hesitate to join the authors in sounding too many alarms. Scrutiny of these cases suggests that AFE may be over-reported.Īlthough the findings of this study are interesting-particularly the association between AFE and induction of labor, twin gestation, cesarean delivery, and the combination of older age and ethnic-minority status-they must be interpreted with caution. One of the strengths of the study is the use of a comprehensive database, which made it possible to exclude 26 additional cases originally diagnosed as AFE but determined to be another entity. Incidence, risk factors, management and outcomes of amniotic-fluid embolism: a population-based cohort and nested case-control study Academic research paper. 4McLeod, A.G.W.(1972) Fatal amniotic fluid embolism in Dade county: an unusual incidence. 3Gregory, M.G.& Obstetrics and Gynecology, 45, 236. 2Lumley, J., Owen, R.& Report of three cases. Journal of the Irish Medical Association, 66, 51. Their analysis of these cases, along with the cases of 1,227 women in the control group, is a valuable contribution to our understanding of AFE-an entity that few obstetricians will have the occasion to manage in their professional careers. References 1Courtney, L.D.(1973) Amniotic fluid embolism. 29Ī Direct obstetric causes normally include obstetric haemorrhage, amniotic fluid embolism, pregnancy-related hypertension, and puerperal infection indirect obstetric causes normally include heart disease, liver disease, venous thrombosis and pulmonary embolism in pregnancy, pneumonia and other diseases.Three risk factors-induction of labor, cesarean delivery, and multiple pregnancy-are associated with amniotic fluid embolismįrom February 2005 to February 2009, Knight and associates identified a total of 60 cases of AFE in the UK Obstetric Surveillance System. Generally, over 75 per cent of maternal and neonatal deaths are preventable or can be treated by providing necessary obstetric services. However, in 2017, there was a rebound, when 53.9 per cent of maternal deaths were brought about by direct obstetric causes. ![]() During the 2015–2016 period, deaths brought about by direct obstetric causes were less than those as a result of indirect obstetric causes. ![]() This proportion has decreased steadily during the 2000–2010 period, with some fluctuations around 50 per cent since then. Before 2000, direct obstetric causes a accounted for over 70 per cent of maternal deaths. Although obstetric haemorrhage is still the leading cause of maternal mortality, it has declined from over 40 per cent of maternal deaths before 2005 to 28.6 per cent of maternal deaths in 2017. Obstetric haemorrhage, amniotic fluid embolism, and pregnancy-related hypertension were the three leading causes of maternal mortality in 2017. Source: National Health Commission, China Health Statistical Yearbook, 2018
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